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General NPI Number Information
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NPI Number | 1043363567
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Entity Type | Organization
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Legal Business Name | LDS FAMILY SERVICES
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 6120 EARLE BROWN DR STE 210
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-4107
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Country | US
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Telephone | 763-560-0900
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Fax | 763-560-1288
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Provider Business Mailing Address
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Address Line | 6120 EARLE BROWN DR STE 210
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-4107
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Country | US
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Telephone | 763-560-0900
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Fax | 763-560-1288
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MARK T. HALES
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Credential | LICSW
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Telephone | 763-560-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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